Representing 62% of the treatments centers, hospitals overwhelmingly constituted the largest group, with only 31% of centers classified as for-profit. Centers of both types averaged approximately 115 clients each, ranging, on average, over four or five levels of care. The demographic composition of the couselor workforce was 57% female, 13% minority group members, 50% with graduate degrees, 56% certified, and 37% in recovery. Counselors' salaries averaged $30,134, with a range of $15,000 -- $62,640. With respect to the client population, an average of 54% had experienced a relapse. Twenty-nine percent will in a program due to a court mandate. Twenty-six percent of clients were covered by Medicaid and 18% were covered by managed care.
Discussion
McNulty et al. tested ten hypotheses in four conceptual blocks of variables. Their "key hypotheses" (p. 173) concerned the role of management practices. They were careful, in formulating hypotheses, not to assume causal relationships between management practices and center and workforce characteristics. They did note, however "the model considers center characteristics first because…workforce and client composition are perhaps shaped in part by the structural/operation features of treatment centers (p. 173). Factors under study in their hypotheses are not independent of one another, as the tabulation of multivariate sustainability indicates.
In discussing reliability of the study, there are several points that are worthy of consideration. The first is with respect to the nature of the factors considered in forming the hypotheses and then subsequently measured and studied. Examination of the factors shows that they are objective measures and, in some instances, binary. The nature of the facility, for example, is binary; it is either for-profit or hospital-based. Factors such as counselor-client ratio, size of the facility, classification of facility (inpatient, outpatient, or both), salary ranges, and opportunities for mobility are generally stable but can, dependent upon circumstances, be changeable to an extent. Factors such as education levels and attainment of certification may also be relatively stable in that facilities may have established mandates for hiring. Factors such as gender composition of the workforce, racial and ethnic composition, and recovery status among members of the workforce has the most potential for change within and across institutions; as with education and certification attainment, however, organizations may have mandated quotas to meet in hiring practices.
The subjective factors in the study are the scaled-response survey questions completed by counselors in the facilities studied. The study by McNulty et al. does not have any way of controlling or accounting for the emotional states of counselors or personal or professional experiences they may have had that will influence their responses.
Survey questions cannot control for individuals who, as a matter of practice, never select the strongest response in a set. Responses to questions about participatory management will be influenced by each employee's experiences. For example is the statement "The center's management makes sure that employee concerns are heard before decisions are made" (p. 188). Responses could be affected by an employee's own experience, the experience or a colleague, hearsay, or an employee's perception of a typical management response. There is no provision for factoring in an employee's length of service and whether dissatisfaction, as expressed in this response or others, reflects a single incident...
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